KANSAS OWNERSHIP CHANGE FORM
KANSAS OWNERSHIP CHANGE FORM
RCN - FOR OFFICE USE ONLY
Name of business: _____________________________________________________ EIN: ___ ___ __ ___ ___ ___ ___ ___ ___
Complete the following information so your customer profile can be maintained with the most current information. You may copy this form if more space is needed. Important--If a business fails to report or pay appropriate state taxes, any individual who is responsible for the tax authorizes the Secretary of Revenue to research the credit history of the business or that individual.
Check the appropriate box:
Adding a name
Removing a name
__________________________________________________ _______________________________________________
Printed full proper name of Owner, Partner, or Corporate Officer
Signature of Owner, Partner, or Corporate Officer
SSN / EIN (Check one) ____________________________________ Title ____________________________________________
Home address (street, city, state, zip code) ___________________________________________________________________________
Home phone _____________________ Email ___________________________________ Percent of Ownership ______ %
Do or did you have control or authority over how business funds or assets are spent? Yes No
Date you became the owner, partner, corporate officer or LLC member; or the effective date to remove your name as the owner,
partner, corporate officer or LLC member of this business. Month ________ Day ________ Year ________
Check the appropriate box:
Adding a name
Removing a name
__________________________________________________ _______________________________________________
Printed full proper name of Owner, Partner, or Corporate Officer
Signature of Owner, Partner, or Corporate Officer
SSN / EIN (Check one) ____________________________________ Title ____________________________________________
Home address (street, city, state, zip code) ___________________________________________________________________________
Home phone _____________________ Email ___________________________________ Percent of Ownership ______ %
Do or did you have control or authority over how business funds or assets are spent? Yes No
Date you became the owner, partner, corporate officer or LLC member; or the effective date to remove your name as the owner,
partner, corporate officer or LLC member of this business. Month ________ Day ________ Year ________
Check the appropriate box:
Adding a name
Removing a name
__________________________________________________ _______________________________________________
Printed full proper name of Owner, Partner, or Corporate Officer
Signature of Owner, Partner, or Corporate Officer
SSN / EIN (Check one) ____________________________________ Title ____________________________________________
Home address (street, city, state, zip code) ___________________________________________________________________________
Home phone _____________________ Email ___________________________________ Percent of Ownership ______ %
Do or did you have control or authority over how business funds or assets are spent? Yes No
Date you became the owner, partner, corporate officer or LLC member; or the effective date to remove your name as the owner, partner, corporate officer or LLC member of this business. Month ________ Day ________ Year ________
CR-18 (Rev. 8-19)
Send this form and any payments to: Kansas Department of Revenue, PO Box 3506, Topeka KS 66625-3506 or FAX to 785-291-3614. For assistance call 785-368-8222.
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